COPD World News

COPD World News - Week of June 27, 2021

Lung cancer risk elevated in patients with Asthma-COPD overlap

Rochester, NY - Patients with asthma-COPD overlap have elevated risk for lung cancer compared with smokers and similar rates of lung cancer compared with those with COPD, but greater risk than patients with asthma alone, researchers reported. “Our study provides novel additional data about the [asthma-COPD overlap] phenotype and suggests that in terms of risk of lung cancer, these patients behave closer to those with COPD rather than asthma,” than Antonios Charokopos, MD, MSc, assistant professor in the division of pulmonary and critical care at Icahn School of Medicine at Mount Sinai and the Mayo Clinic, Rochester, New York, and colleagues wrote in the Annals of the American Thoracic Society. “These findings also suggest that when assessing the potential indication of lung cancer screening or evaluating the work-up of pulmonary nodules, physicians should consider [asthma-COPD overlap] patients to be at independently increased risk for lung cancer.” Researchers evaluated the relationship between asthma-COPD overlap and lung cancer risk in 13,939 smokers from the National Lung Cancer Screening Trial with baseline spirometry measures, used spirometric indices and childhood asthma history. To compare unadjusted and adjusted lung cancer risk, investigators categorized participants into the following groups: asthma-COPD overlap with childhood asthma history (n = 208; mean age, 61 years), COPD without childhood asthma history (n = 4,428; mean age, 62 years), smokers with asthma and childhood asthma history (n = 281; mean age, 59 years), Global Initiative for COPD-Unclassified with no airway obstruction but decreased FEV1 less than 80% predicted without childhood asthma history (n = 2,547; mean age, 61 years) or normal spirometry (n = 6,447; mean age, 60 years). Among all participants, there were 604 lung cancer cases diagnosed. The incidence rate of lung cancer was 13.2 per 1,000 person-years (95% CI, 8.1-21.5) in the asthma-COPD overlap group, 11.7 per 1,000 person-years (95% CI, 10.5-13.1) in the COPD group, 1.8 per 1,000 person-years (95% CI, 0.6-5.4) in smokers with asthma, 7.7 per 1,000 person-years (95% CI, 6.4-9.2) in the Global Initiative for COPD-Unclassified group and 4.1 per 1,000 person-years (95% CI, 3.5-4.8) in the normal spirometry group. After adjusting for other risk factors, patients with asthma-COPD overlap had an increased risk for lung cancer compared with patients with asthma (incidence RR = 4.5; 95% CI, 1.3-15.8) and those with normal spirometry (incidence RR = 2.3; 95% CI, 1.3-4.2). However, there was no difference in adjusted lung cancer incidence among patients with asthma-COPD overlap and patients with COPD (incidence RR = 1.2; 95% CI, 0.7-2.1). According to the researchers, these data may aid in assessing patients for lung cancer screening and estimating the likelihood of lung cancer among pulmonary nodules. “Future studies, should evaluate the mechanisms mediating the increased risk of lung cancer in this patient group,” the researchers wrote.

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COPD World News - Week of June 20, 2021

NACI recommends second dose following AstraZeneca be mRNA vaccine

Ottawa, ON - On June 17, 2021, the Public Health Agency of Canada released updated recommendations from the National Advisory Committee on Immunization (NACI) on first and second doses of COVID-19 vaccines authorized for use in Canada. These updates are based on current scientific evidence and NACI expert opinion. NACI reviews new scientific evidence on COVID-19 vaccines on an ongoing basis and revises its guidance on the use of authorized vaccines accordingly. Due to the rapid emergence of new evidence, NACI issues updates to its guidance regularly. In making its recommendations, NACI considered: The increasing availability of mRNA vaccines (Pfizer-BioNTech, Moderna) in Canada; Emerging evidence suggesting better immune responses when a first dose of the AstraZeneca vaccine is followed by a second dose of the Pfizer-BioNTech mRNA vaccine; The risk of Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) associated with viral vector vaccines (AstraZeneca, Janssen) but not associated with mRNA vaccines (Pfizer-BioNTech, Moderna); and Principles of ethics, equity, feasibility, and acceptability. For first doses, NACI recommends that: An mRNA vaccine (Pfizer-BioNTech, Moderna) is preferred to start a vaccine series, unless there is a contraindication, for example, because of an allergy to an mRNA vaccine or its components. A viral vector vaccine (AstraZeneca, Janssen) may be offered to start a vaccine series when an mRNA vaccine is inaccessible or contraindicated, for example, because of an allergy to an mRNA vaccine or its components. NACI's previous recommendation - that people who wanted earlier vaccination could receive a viral vector vaccine rather than wait for an mRNA vaccine - reflected the limited supply of mRNA vaccines at the time and the imperative of protecting vulnerable populations from serious illness and death from COVID-19. For second doses, NACI recommends that: Individuals who received a first dose of an mRNA vaccine (Pfizer-BioNTech, Moderna) should be offered the same mRNA product for their second dose. If the same product is not readily available, or the product used for the first dose is unknown, another mRNA vaccine is considered interchangeable and should be used to complete the series. An mRNA vaccine is now preferred as the second dose for individuals who received a first dose of the AstraZeneca/COVISHIELD vaccine, based on emerging evidence of a potentially better immune response from this mixed vaccine schedule and to mitigate the potential risk of VITT associated with viral vector vaccines. People who received two doses of AstraZeneca/COVISHIELD vaccine can rest assured that the vaccine provides good protection against infection and very good protection against severe disease and hospitalization. Receiving a second vaccine dose for a two-dose schedule is essential to provide better and longer-term protection against COVID-19 for individuals and for the entire community. NACI continues to closely monitor the evolving evidence on COVID-19 vaccines and will update recommendations as needed.

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COPD World News - Week of June 13, 2021

Virtual medical care is here to stay post-pandemic

Vancouver, BC - Seeing a health-care professional via video or telephone has improved patient care access in British Columbia and will continue after the threat of COVID-19 subsides, says the leader of the organization that represents thousands of physicians across the province. Dr. Ramneek Dosanjh, president-elect of Doctors of B.C., said virtual appointments increased fourfold during the pandemic — and the option of seeing a doctor remotely is here to stay. "I think that we will not go back to the pre-pandemic virtual care levels," Dosanjh told CBC's The Early Edition recently. "The future is here and the goal is now to just navigate the road ahead." Dosanjh says it is important to have in-person appointments with your doctor as some medical concerns should be physically examined. She said virtual appointments can be efficient and effective for follow-up care, prescription refills and mental health check-ins. Virtual appointments can also greatly benefit British Columbians with mobility issues or those who live in rural communities where accessing the doctor's office is a challenge. "It's enabled them to access care in a way that they previously weren't able to," said Dosanjh. But Dosanjh does have some concerns about the increasing use of phone and video appointments — one being that patients may not know if they have a situation requiring urgent care. She said it's also important that increased virtual appointments do not result in "fragmented care" for British Columbians who could end up "jumping from doctor to doctor" rather than receiving continuous care from their family physician or specialist. A Canadian Medical Association (CMA) survey released last June suggested 47 per cent of Canadians used virtual care such as calls, email, texts or video during the pandemic. Of these, 91 per cent said they were very satisfied with the experience.

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COPD World News - Week of June 6, 2021

WHO calls out widening global vaccine gap

Geneva - As wealthier countries like Canada begin to vaccinate kids and low-risk populations, health workers and other vulnerable groups in poorer countries remain unprotected, suffering disproportionately from a pandemic with no end in sight. The widening global vaccine gap is a “scandalous inequity” that is prolonging the pandemic for everyone, World Health Organization Director-General Tedros Adhanom Ghebreyesus told delegates from 194 member states at the annual assembly Monday. “There is no diplomatic way to say it: a small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world,” he said. More than three-quarters of the world’s vaccines have been administered in just 10 countries. The WHO is urging wealthier nations to stop vaccinating kids and other low-risk groups and share shots with poorer countries instead, with the aim to vaccinate 10 per cent of the global population by September. In Africa, less than two per cent of the population has received one dose of a COVID-19 vaccine, compared to the more than 50 per cent vaccinated in Canada. Lower- to middle-income countries primarily rely on COVAX, the global vaccine-sharing initiative, to access doses but supply has been vastly inadequate: the 72 million COVAX doses shipped so far have barely covered one per cent of the combined population of 125 receiving countries, Tedros said. Lower-income countries were recently hit with the news that the main supplier for COVAX, the India-based Serum Institute, was freezing exports until at least the end of the year as it focuses on its domestic population.  COVID-19 has hit India with a ferocity not seen since the pandemic began, with the virus claiming more lives there per week than Canada has recorded in the past 14 months and bringing the health-care system to near-total collapse. When Ananya Tina Banerjee, an epidemiologist at McGill University, got her first dose of the COVID-19 vaccine, she didn’t feel a sense of joy or relief shared by many. She felt guilty to have been offered a life-saving vaccine while so many vulnerable people around the world lack access.  Beyond the ethical issues associated with wealthier countries hoarding vaccines, as long as COVID-19 continues to spread unfettered around the world there is a higher possibility of new variants emerging that can seep across borders and threaten vaccine protection. The B.1.617.2 variant first identified in India “didn’t develop there out of chance,” said Dr. Zain Chagla, infectious disease physician at St. Joseph’s Healthcare Hamilton. “It was large-scale transmission amongst a large population that led to variant evolution … those variants have the risk of completely unravelling our vaccination campaign if they escape vaccine immunity.” The only way to end the global pandemic is by boosting global immunity, rather than protecting a few countries while ignoring the needs of the rest. But as Canada continues to expand its rollout, it can be difficult to know when to draw the line. Ultimately, decisions about who gets prioritized for a vaccine should be made based on who is most likely to be hospitalized and die from COVID-19 — whether that person is in Canada or anywhere else in the world, Chagla said.

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COPD World News - Week of May 30, 2021

New study finds number of smokers has reached all-time high of 1.1 billion

London, UK - Smoking killed almost 8 million people in 2019 and the number of smokers rose as the habit was picked up by young people around the world, according to new research. A study published in the Lancet on Thursday said efforts to curb the habit had been outstripped by population growth with 150 million more people smoking in the nine years from 1990, reaching an all-time high of 1.1 billion. The study’s authors said governments need to focus on reducing the uptake of smoking among young people, as 89% of new smokers were addicted by the age of 25 but beyond that age were unlikely to start. “Young people are particularly vulnerable to addiction, and with high rates of cessation remaining elusive worldwide, the tobacco epidemic will continue for years to come unless countries can dramatically reduce the number of new smokers starting each year,” said the study’s lead author Marissa Reitsma, a researcher at the Institute for Health Metrics and Evaluation. Though the prevalence of smoking has reduced globally over the past three decades, it increased for men in 20 countries and for women in 12. Just 10 countries made up two-thirds of the world’s smoking population: China, India, Indonesia, the US, Russia, Bangladesh, Japan, Turkey, Vietnam and the Philippines. One in three tobacco smokers (341 million) live in China. In 2019, smoking was associated with 1.7 million deaths from ischemic heart disease, 1.6 million deaths from chronic obstructive pulmonary disease, 1.3 million deaths from tracheal, bronchus and lung cancer, and nearly 1 million deaths from stroke. Previous studies have shown that at least half of long-term smokers will die from causes directly linked to smoking, and that smokers have an average life expectancy 10 years lower than those who have never smoked. The research examined trends in 204 countries and was produced as part of the Global Burden of Disease consortium of researchers, which studies health issues that lead to death and disability. According to the study, half of all the countries had made no progress in stopping uptake among 15- to 24-year-olds and the average age for someone to start was 19, when it is legal in most places. Reitsma said the evidence suggested that if young people faced delays in picking up the habit, they would be less likely to end up becoming smokers at all. “Ensuring that young people remain smoke-free through their mid-20s will result in radical reductions in smoking rates for the next generation,” said Reitsma. Despite 182 countries signing a 2005 convention on tobacco control, enforcing policies to reduce smoking had been varied. Researchers said taxation was the most effective policy but there was a significant discrepancy between the high cost of a packet of cigarettes in developed countries and a significantly lower costs in low- and middle-income countries. The study’s co-author, Vin Gupta, said there needed to be stronger commitment to tackling smoking, as well as products such as flavoured cigarettes and e-cigarettes that could be enticing young people. “Despite progress in some countries, tobacco industry interference and waning political commitment have resulted in a large and persistent gap between knowledge and action on global tobacco control,” said Gupta. “Bans on advertising, promotion and sponsorship must extend to internet-based media, but only one in four countries have comprehensively banned all forms of direct and indirect advertising.”

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COPD World News - Week of May 23, 2021

NACI recommends same shot vaccine when it comes to 2nd doses

Ottawa, ON - The National Advisory Committee on Immunization has updated its guidance on second shots, recommending that patients receive the same vaccine in round two as they did at their first appointment. But if that vaccine is unavailable, NACI suggests taking Johnson & Johnson in place of Oxford-AstraZeneca, and taking Moderna in place of Pfizer-BioNTech – both are mRNA vaccines – or vice-versa. When it comes to the viral vector vaccines AstraZeneca and J&J, however, the question is moot for the time being. Plans to distribute the initial 300,000-dose shipment of Johnson & Johnson remain on hold after Health Canada learned parts of the batch were manufactured at a Maryland facility mired in quality-control problems. An mRNA vaccine in place of a second AstraZeneca shot may be an option, but NACI is waiting on more data. A Spanish study released initial results last week showing a second dose of Pfizer for AstraZeneca recipients produced a stronger immune response, but more information is pending. A U.K. study earlier this month found that the same sequence produced some stronger initial side effects, but that they were temporary and mixing the vaccines was deemed safe. Further data on whether the blend yields similar or better results than two doses of the same vaccine is expected in a few weeks. Matthew Tunis, executive secretary to NACI, told a parliamentary health committee Friday that AstraZeneca recipients should wait 12 weeks to get a second dose in order to elicit a stronger immune response. NACI has previously said that up to 16 weeks will suffice.

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COPD World News - Week of May 16, 2021

The CDC shouldn’t have removed restrictions without requiring proof of vaccination

Washington, DC – Opinion by Dr. Leana S. Wen for The Washington Post.

For months, I have been criticizing the Centers for Disease Control and Prevention for being too cautious with its guidance for what fully vaccinated people can do. I saw little incentive for people to be vaccinated against covid-19 if they had to keep wearing masks, avoiding gatherings and refraining from nonessential travel. On Thursday, the CDC abruptly reversed course, announcing that fully vaccinated people can essentially resume all aspects of pre-pandemic life. This announcement would be very welcome if not for one big problem: There is no concurrent requirement for proof of vaccination. Without it, the CDC announcement could end up increasing confusion, removing incentives for those yet to be inoculated and delaying the eventual goal of herd immunity that would get society truly back to normal. Don’t get me wrong, I agree with CDC Director Rochelle Walensky that there is extensive and growing evidence that those who are vaccinated are very well protected from becoming ill and spreading the coronavirus to others. In fact, the most recent data from the CDC reports only 9,245 infections in 95 million fully vaccinated people, an infection rate of less than 0.01 percent. As I’ve written before, if you’ve reached the two-week threshold after inoculation, you should feel free to be rid of restrictions for yourself. The problem is this: You know what you’re doing, but you have no way to be confident of trusting everyone else. Let’s say you go the grocery store. It’s crowded and few people there are masked. Perhaps everyone is vaccinated, but perhaps not. What if you’re vaccinated but not fully protected because you’re immunocompromised? You can no longer count on CDC rules to help you keep safe. What if you don’t have child care, so you had to bring your kids along? They didn’t choose to remain unvaccinated — the shots aren’t available for them. Surely, it’s not fair to put them at risk. Here’s another example. As employers are formulating return-to-work policies, many employees are expressing that they are nervous about coming back in person. What reassures them is if the workplace continues to abide by mitigation measures such as masking and distancing, or, in its place, the employer requires vaccination. Imagine, if you will, now being scheduled to come into an office where vaccination isn’t checked and masking is, therefore, optional. And what about the broad danger of enabling and encouraging people who never wanted to wear masks and refuse to be vaccinated? They could spread the virus among themselves, freed from inhibition. By resorting to the honor code, the CDC is removing a critical incentive to vaccination. Many who were on the fence might have been motivated to get the shot because they could go back to activities they were missing, without a mask. Now, if no one is checking, and they can do everything anyway, why bother? As one senior local health official in Maryland told me, “This announcement at this stage makes zero sense. We’re dropping off a cliff with demand already on vaccinations. This will further remove individual incentive to get a shot.” He likened the CDC’s decision-making to “throwing darts at random” — that’s how much trust he now has in this once-revered institution. To be sure, the CDC is still saying that masks are needed in certain settings including airplanes, hospitals and nursing homes. Individual businesses are still able to make their own requirements. However, businesses often depend on the CDC to back up their policies. Many were already under pressure to drop mask mandates. Now, who will stop a mask-less person from walking into an establishment, self-identifying as being vaccinated, acting as they choose and citing the CDC as the reason they can potentially endanger others? The CDC has gone from one extreme to the other, from over-caution to throwing caution to the wind. Its new guidance could have been exactly what we needed to encourage vaccination, but it skipped a key step. It should be revised to say that fully vaccinated people should have no restrictions on their public activities if vaccination status can be verified. That means stores, theaters and restaurants can be at full capacity, without masks, if they check vaccination status. The CDC should also set a level of community vaccination, at which point they can do away with this step — for example, if 70 percent of a community is vaccinated, everyone can take off their masks, vaccinated or not. We’ve come a long way in the pandemic, but not as far as the CDC has suddenly taken us. The vaccinated may be well-protected, but let’s not forget our obligation to those who do not yet have immunity — and our commitment to end this pandemic once and for all.

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COPD World News - Week of May 9, 2021

Cannabis vaping skyrockets in high school students

New York, NY - Just as reports of severe lung illnesses related to vaping began to make headlines in 2019, rates of cannabis vaping among high school students were soaring, according to high-quality survey data. Results from the long-running Monitoring the Future study showed that 4.9% (95% CI 4.3%-5.5%) of high school students reported "frequent" vaping of cannabis products -- 10 or more times in the previous month -- up from 2.1% in 2018 (95% CI 1.7%-2.6%), reported Joseph J. Palamar, PhD, of New York University. The study was funded by the National Institute on Drug Abuse. Rates of any cannabis vaping in the previous month also increased dramatically, from 7.5% in 2018 (95% CI 6.7%-8.4%) to 14.0% in 2019 (95% CI 13.1%-14.9%), he wrote in the Journal of Adolescent Health. Cannabis vaping involves inhalation of evaporated oils or from heated concentrates known as dabs. These increases accompanied what was the most frightening, and still somewhat mysterious, respiratory disease outbreak in recent years, until it was eclipsed by the COVID-19 pandemic. Nearly 3,000 Americans, mostly young adults, fell ill with EVALI -- e-cigarette or vaping-associated lung injury -- and 68 died, Palamar noted. Epidemiological and lab research eventually settled on vitamin E acetate, a common component of illicit cannabis vaping products, as the likely cause, even though a substantial minority of victims denied use of such products. Palamar's analysis drew on Monitoring the Future data on 4,072 students in 10th and 12th grades in 2018 and 8,314 in 2019. Past-month cannabis vaping nearly tripled among female students from 2018 to 2019. Rates for students age 18 and older rose 2.5-fold. Social activity, as indicated by reports of "going out" four to seven times a week, was associated with above-average rates of cannabis vaping. Small increases from 2018 to 2019 in cannabis vaping were seen among students reporting other psychoactive drug use including opioids, cocaine, "tranquilizers," and non-LSD hallucinogens. An open question, not addressed in Palamar's study, is the extent to which school closures and social restrictions resulting from the COVID-19 pandemic affected these trends, and Monitoring the Future data won't shed light on that for some time. That's because the survey was stopped in March 2020, as school closures took hold. Sill, the survey's truncated 2020 data showed that the number of 10th graders saying cannabis was "fairly easy" or "very easy" to obtain declined sharply, accelerating a trend underway for more than 20 years, and despite the spread of legal marijuana. Palamar noted several limitations to his analysis and to Monitoring the Future in general. Drug use data came from unverified self-report, and the survey is conducted at participating schools, meaning that students "chronically absent or who dropped out are underrepresented," he wrote. Also, some subgroups were too small to permit detailed examination, such as students reporting daily cannabis vaping.

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COPD World News - Week of May 2, 2021

Secondhand smoke increases risk for oral cancer

London, UK - There is a statistically significant association between secondhand smoke and the risk for oral cancer, researchers wrote in Tobacco Control. “This is the first systematic review to answer this research question,” Saman Warnakulasuriya, BDS, PhD, DSc, a professor at King's College London and WHO Collaborating Centre for Oral Cancer, told Healio Primary Care. Oral cancers — those of the lip, oral cavity and oropharynx — are responsible for 447,751 new cases of cancer and 228,389 deaths worldwide each year, according to 2018 estimates from the GLOBOCAN database. Major risk factors for oral cancer include smoking tobacco and using smokeless tobacco, drinking alcohol and chewing betel quid — a mixture of areca nut, tobacco, spices and other ingredients. Data from 192 countries show that about one-third of adult nonsmokers and 40% of children inhaled secondhand smoke during a 1-year period. According to Warnakulasuriya, several of his patients who did not have the known risk factors were diagnosed with oral cancer. This prompted his research team to search “for evidence of whether [secondhand smoke] could be a factor for oral cancer, particularly in nonsmokers.” They reviewed five case-control studies conducted from 2008 to 2019 — three from Asia, one from Europe and one conducted in North America and Europe — that included 1,179 cases and 5,798 controls. Secondhand smoke exposure was reported in 3,452 people.  According to the researchers, the overall OR for oral cancer among those exposed to secondhand smoke was 1.51 (95% CI, 1.2-1.91). In addition, individuals who were exposed to secondhand smoke for more than 10 or 15 years were at greater risk for oral cancer (OR = 2.07; 95% CI, 1.54-2.79) compared with nonexposed individuals. The findings were consistent across the studies, they added. “We think the findings will come as a surprise to many as very little has been spoken on [secondhand smoke] as a possible etiological factor for oral cancer,” Warnakulasuriya said. Multiple stakeholders can benefit from the findings, he said.  Physicians who have “a nonsmoker who is suspected of oral cancer, a family history of smoking or exposure to smoke at the workplace environment may be worth inquiry to establish the possible cause,” Warnakulasuriya said.  He added that for policy makers, the findings offer “additional support to enforce bans on smoking in enclosed environments [and] to society, to protect others from harm from exhaled and side stream smoke generated by smokers.”

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COPD World News - Week of April 25, 2021

One-year health status of the COPD multi-dimensional phenotypes

Rome, Italy - This study was carried out to present the 1-year evolution of symptoms and health status in chronic obstructive pulmonary disease (COPD) patients enrolled in the STORICO study (observational study on characterization of 24-h symptoms in patients with COPD) classified in multidimensional phenotypes (m-phenotypes). An exploratory factor analysis was conducted to distinguish clinical and pathophysiological variables having the greatest classificatory properties, followed by cluster analysis to group patients into m-phenotypes (mild COPD (MC), mild emphysematous (ME), severe bronchitic (SB), severe emphysematous (SE), and severe mixed COPD (SMC)). Researchers recorded COPD symptoms at baseline, 6-, and 12-month follow-up and their evolution was described as the frequency of patients with always present, always absent, arising’, ‘no more present symptoms. The SGRQ and CASIS questionnaires were used to evaluate QoL and quality of sleep respectively. For the analysis, 379 individuals were examined (144 MC, 71 ME, 96 SB, 14 SE, 54 SMC). As per the findings, severe m-phenotypes exhibited an improvement in night-time symptoms and quality of sleep, but not quality of life over one year. The data exhibited that, being stable over time, m-phenotypes appear worthy of testing for classificatory and prognostic purposes. Members of the study group included: Raffaele Antonelli Incalzi, Francesco Blasi, Nicola Scichilone, Alessandro Zullo, Lucia Simoni, and Giorgio Walter Canonica.

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COPD World News - Week of April 18, 2021

COVID re-infection rates as expected

New York, NY - While federal data on breakthrough COVID-19 infections following vaccination only recently became available, a handful of states and independent health systems have put forward their own analyses, and the findings are reassuring -- the rate of breakthrough infections are as expected. As reported by MedPage Today, Michigan was among the first states to report numbers last week: 246 people who were fully vaccinated (more than 2 weeks out from their second dose) came down with COVID from January to March. Three of those people died. That was out of a total of 1.8 million people in the state who were fully vaccinated at that time, according to the Detroit Free Press. State health department spokesperson Lynn Sutfin told the Free Press that some of those cases may still be excluded after they're fully adjudicated against other CDC criteria, such as not having a positive COVID test less than 45 days prior to their post-vaccination positive. Data from other states suggest similar low rates of breakthrough infection. Oregon, for instance, reported 168 cases of breakthrough infection among more than 700,000 fully vaccinated people as of April 2, with 19 hospitalizations and three deaths. Minnesota reported 89 cases among 800,000 fully vaccinated people as of March 22, with no deaths. Other states that have reported breakthrough cases include Washington (102 cases, eight hospitalizations, two deaths among one million fully vaccinated); South Carolina (155 cases among more than 560,000 fully vaccinated); and Nevada (58 cases among more than 500,000 fully vaccinated). On April 8th, the CDC reported national data, finding 5,800 breakthrough infections, with 396 requiring hospitalization and 74 deaths. The agency has a team that has been monitoring these infections since February, according to the Washington Post. During a White House press briefing last Friday, NIAID Director Anthony Fauci, MD, said he didn't have any concerns about breakthrough infections after vaccination. More than 74 million people in the U.S. have been fully vaccinated as of April 13, according to the CDC's vaccination tracker. "That number of individuals who were breakthrough infections is not at all incompatible with a 90-plus percent vaccine efficacy," Fauci said. "I don't think that there needs to be concern about any shift or change in the efficacy of the vaccine." "There's nothing there yet that's a red flag," Fauci said. "We're obviously going to keep an eye on that very, very carefully." Evidence from health systems also supports low rates of vaccine breakthrough. According to a letter published March 23 in the New England Journal of Medicine, the majority of post-vaccination infections among healthcare workers at the University of California San Diego and the University of California Los Angeles occurred before workers were fully vaccinated. Only seven infections among 36,659 fully vaccinated healthcare workers occurred more than 2 weeks after the second dose, researchers reported. David Perlin, PhD, chief science officer for Hackensack Meridian Health in New Jersey, told MedPage Today that among about 25,000 healthcare workers, only about 100 have tested positive for COVID-19 after vaccination, and most infections were mild. Few were hospitalized and none had severe illness, he said. "It's about the level we expected," Perlin said, adding that there hasn't been any clear pattern as to whether breakthrough infection is being driven by a particular variant -- notably, the B.1.351 or "South African" variant, which has been shown to evade vaccine immunity to some extent. "Among the vaccinated individuals who were virus-positive, we see the occasional E484K mutation, but there's no correlation" with breakthrough infection, Perlin said. "We were concerned about that at first, but with the analysis we've done so far, that does not seem to be the case." Perlin noted that as with the rest of the country, the B.1.1.7 variant is now dominant in New Jersey, and appears to be outcompeting other variants. "N501Y [the key mutation in B.1.1.7] seems very robust and may well outcompete E484K, which has immune escape but is facing selection pressure," Perlin said. But that doesn't mean we should rest easy, he warned. "Once N501Y gets a foothold, it seems to move quickly, but as long as we have infection, and people mount an immune response that's somewhat weak, there will be selection pressure" that can drive further mutation, he said. "That's another reason that, more than ever, we need to vaccinate as quickly as possible."

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COPD World News - Week of April 11, 2021

World Health Organization weighs in on vaccine dosage delays

Geneva, Switzerland - A recent editorial published in the British Medical Journal makes a good case for why the Canadian government’s risky dose-delay strategy to compensate for its failure to procure COVID-19 vaccines is a bad idea. It adds to a wealth of emerging scientific data, which clearly demonstrates that elderly people who have gotten their first dose of vaccine should get their second within the recommended 21 or 28 days, not 16 weeks. “Concerns remain about effectiveness in older adults,” wrote Dominic Pimenta, Christian Yates, Christina Pagel and Deepti Gurdasani in the BMJ on March 18, speaking of the United Kingdom’s 12-week dose delay. The “deviation” from the recommended protocol of 21 days between doses for the Pfizer-BioNTech vaccine was intended to maximize benefit with limited supplies and to minimize hospital admissions and deaths, they noted. “At the time, Pfizer did not support the decision, stating that high efficacy could not be guaranteed.”  And indeed, delaying the second dose creates a new set of problems: “As many people in priority subgroups have not yet received a second dose, any substantial waning of protection during the 12-week interval will create problems as the U.K. starts to reopen.… This is of particular concern for older adults. The World Health Organization also weighed in on the dosage delay strategy by Britain and Canada, “urging the vaccine doses be given 21 to 28 days apart.” The U.S. Centres for Disease Control and Prevention said months ago that people could wait up to 42 days between doses, if necessary, though the agency still advises individuals to stick to the initial schedule “So what gives? How long can you go on a single shot and still stay safe? And what happens if your second shot isn’t available on time?” asked Marla Broadfoot in an article published in Scientific American on March 18. “The first dose primes immunological memory, and the second dose solidifies it,” reads the article, citing Thomas Denny, COO of the Duke Human Vaccine Institute. The first dose of the Pfizer vaccine reduces infections by about 50 per cent, and Moderna’s jab reduces it by around 80 per cent, but both shots offer 95 per cent protection after the second shot, he noted. The CDC increased the duration up to 42 days to provide scheduling flexibility, and no studies were done as to whether this reduced the vaccine’s effectiveness. “We don’t have the greatest science, at this point, to say we are 100 per cent comfortable doing a booster 35, 40 days out,” Denny added. “We are deferring to the public health concerns and the belief that anything we can do right now is better than nothing.”

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COPD World News - Week of April 4, 2021

People with long-COVID at high risk of depression and PTSD

London, UK - People living with long-COVID are at significant risk of experiencing depression and post-traumatic stress disorder (PTSD), according to research published in the European Respiratory Journal. The research is one of the first long-term follow-up studies of people who presented at hospital with COVID-19. Researchers found that a significant proportion of patients who attended hospital, whether admitted or discharged from the emergency department and regardless of disease severity, experienced an ongoing mental health burden – 14% showed signs of depression and 11% experienced PTSD. The researchers say that COVID-19 patients should be routinely monitored for psychological distress in post-COVID care to ensure that they recover both physically and mentally. Dr Swapna Mandal, Consultant Respiratory Physician at the Royal Free London NHS Foundation Trust, UK, was a lead researcher on the study. She said: “Whilst caring for COVID patients we could see the mental health effects; patients were terrified by what was happening to them and what they were seeing around them. Many people who have had COVID-19 report adverse mental health after the infection has cleared, but up to now, there have been very few long-term studies focused on this issue. “Based on these concerns, when we set up our post-COVID follow-up clinics we sought to monitor the psychological consequences among patients. We screened for depression and PTSD so that we could support our patients to get the right help and to gain insight in to how prevalent these long-term effects are.” Researchers conducted virtual follow-up care with 760 patients who presented at the Royal Free London NHS Foundation Trust, UK, with COVID-19 including those who were treated in the emergency department (112 patients), inpatient wards (558) and intensive care unit (90). The respondents’ average age was 60 years and the cohort comprised 60% male and 48% of black or minority ethnic background. Patients were followed-up at nine weeks and screened for psychological distress using the Patient Health Questionnaire 2-item scale, which assesses depression by asking about the frequency of depressed mood in the past two weeks, as well as the Trauma Screening Questionnaire, another self-report tool that is designed to identify those experiencing PTSD. The questionnaire data showed that at approximately nine weeks after discharge, a significant proportion of patients who had attended the hospital experienced varying levels of ongoing mental health burden. Around 105 patients (14%) of those receiving follow-up care showed signs of depression and 80 patients (11%) experienced symptoms of PTSD. The data also showed that patients who experienced depression or PTSD were more likely to have ongoing physical symptoms, such as breathlessness and muscle pain, and they were less likely to have returned to work at nine weeks’ follow-up. Dr Mandal said: “Our results show very clearly that among those who we provided post-COVID care for, many have experienced some level of poor mental health during their recovery. All health professionals who are involved in the care of those with long-COVID must be aware of this and should actively screen patients for symptoms, even in those with pre-existing mental health issues. It is vital that multidisciplinary clinics are established to manage all aspects of long-COVID symptoms in a holistic manner, so that patients are able to fully recover.” When the researchers accounted for others factors that can impact mental health – such as the patients’ age, sex, socioeconomic status, and ethnicity; whether they had any existing illness and related symptoms; or if they presented with worse COVID-19 symptoms – they found that the increased prevalence of depression or PTSD among long-COVID patients remained. Dr Mandal explained: “Interestingly, our data suggests there were no significant differences in the levels of depression or PTSD between ethnic groups, nor among those admitted to the ICU when compared with patients admitted to inpatient wards or those who presented at the emergency department, suggesting that disease severity does not impact the likelihood of experiencing ongoing mental health issues. “However, as our respondents included only those who had attended the emergency department or stayed in the hospital, the analysis of the relationship between mental health and disease severity is somewhat limited. Future studies should investigate this further by looking at patients who were treated in primary care settings, such as GP clinics and those who self-treated at home following doctors’ or official advice.” Professor Anita Simonds, President of the European Respiratory Society and Consultant in Respiratory and Sleep Medicine at Royal Brompton Hospital, UK, was not involved in the research. She said: “The results of this long-term study support that individuals who have had COVID-19 are at-risk of worsening mental health. Research on other long-term lung conditions like asthma and COPD suggests that addressing patients’ anxiety or mental ill health can improve their quality of life and ability to keep physically active, which may help with symptom management and recovery in the long run. Health professionals who are caring for those with long-COVID should monitor mental health and ensure patients can access local psychological services alongside respiratory rehabilitation. “Long-COVID treatment is likely to become a large burden on health systems around the world, so is it vitally important that clinics equally address the physical and mental health symptoms of long-COVID and that policymakers ensure clinics have the resources to offer this multidisciplinary care.” The researchers say they were not able to screen patients for depression or PTSD on admission to hospital, so it is not clear if some patients had pre-existing mental health issues or were undiagnosed.

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COPD World News - Week of March 28, 2021

Sanofi to build new vaccine plant

Toronto, ON - Today, Sanofi announced an investment of approximately C $ 925 million in a new vaccine manufacturing facility to be built at its current site in Toronto , Canada . The investment in such a facility will increase the antigen production and filling capacity for Sanofi's high-dose FLUZONE ® Quadrivalent influenza vaccine , thereby increasing its supply in Canada , the United States and Europe. “As a leader in vaccine manufacturing, we are constantly looking to the future to meet the growing demand for influenza vaccines that have demonstrated clinical superiority over standard dose vaccines. This new investment in the manufacture of the high-dose FLUZONE ® Quadrivalent vaccine will help ensure better protection of older people around the world against influenza and its complications. In addition, this vaccine will be a key resource to help fight future pandemics” said Paul Hudson, CEO of Sanofi." We salute the ongoing partnership with the Canadian authorities, who have provided us with their support to bring this major project to fruition which will make Canada - which has a solid heritage in vaccine research and development - one of our main centers in our efforts to protect and improve human health worldwide.  "In addition to manufacturing Sanofi's high-dose FLUZONE ® Quadrivalent influenza vaccine , this new manufacturing facility will strategically grow the biofabrication sector in Canada and build industrial-scale capacity to better prepare Canada for future pandemics.

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Pfizer begins early-stage study of oral COVID-19 drug

New York, NY - Pfizer Inc has started an early-stage U.S. trial of an oral COVID-19 antiviral therapy that could be prescribed to patients at the first sign of infection, the company said recently. The drugmaker, which developed the first authorized COVID-19 vaccine in the U.S. with Germany's BioNTech SA, said the antiviral candidate showed potent activity against SARS-CoV-2, the virus that causes COVID-19, in lab studies. Pfizer's candidate, named PF-07321332, is a protease inhibitor that prevents the virus from replicating in cells. Protease inhibitors have been effective at treating other viral pathogens such as HIV and hepatitis C virus, both on their own and in combination with other antivirals, the company said. Pfizer believes this class of molecules may provide well-tolerated treatments against COVID-19, as currently marketed therapeutics that work on the same lines have not reported safety concerns. The company is also studying an intravenously administered antiviral candidate in an early-stage trial in hospitalized COVID-19 patients. "Together, the two (oral and intravenous candidates) have the potential to create an end-to-end treatment paradigm that complements vaccination in cases where disease still occurs," Pfizer's Chief Medical Officer Mikael Dolsten said in a statement. Pfizer's candidate is behind two other oral antiviral therapies, which are in mid-stage trials – the first being developed by rival Merck & Co with Ridgeback Bio, and a second from Roche Holding and Atea Pharmaceuticals. Gilead Sciences' remdesivir is currently the only U.S. Food and Drug Administration-approved drug for the treatment of COVID-19. The FDA has granted an emergency authorization to intravenous therapies from Eli Lilly - bamlanivimab alone and in combination with etesevimab, and a combination therapy from Regeneron.

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COPD World News - Week of March 21, 2021

Thrombosis Canada issues statement on AstraZeneca vaccine and blood clots

Toronto, ON – Thrombosis Canada has reviewed recent reports from the United Kingdom and Europe relating to the SARS-CoV-2 (COVID-19) vaccine made by AstraZeneca and the development of a very rare type of thrombosis (blood clots) that is associated with thrombocytopenia (low blood platelets). It is the view of Thrombosis Canada that, based on all available evidence, people who receive the AstraZeneca vaccine are not at increased risk of developing blood clots when compared with the general population. However, the AstraZeneca vaccine may be associated with extremely rare cases of blood clots that occur in the brain (called cerebral sinus vein thrombosis) and are associated with low blood platelets. These blood clots were found to occur in 1 in 250,000 to 1 in 500,000 people who received the vaccine. By comparison, people who have COVID-19 are at much higher risk of developing blood clots, which occur in about 1 in 20 people who are in hospital with COVID-19 and in about 1 in 100 people who have COVID-19 but are not in hospital. “Thrombosis Canada strongly recommends that people receive vaccinations for COVID-19, including the vaccine made by AstraZeneca” says Thrombosis Canada President, Jim Douketis, “that’s what we are telling the many patients who have been asking us because of the reports from Europe. The benefits of preventing blood clots and other disease caused by COVID-19 far outweigh any possible risks, which we consider very low.” Thrombosis Canada further strongly recommends that the following groups of people receive vaccinations for COVID-19:

1)            people who have had a previous blood clot

2)            people with a family member who has developed a blood clot

3)            people with a hereditary clotting tendency (e.g., factor V Leiden mutation)

4)            people who are receiving blood thinner medications

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COPD World News - Week of March 14, 2021

COVID-19 test authorized for home use

San Diego, CA - One year into the pandemic, the FDA has authorized its first molecular COVID-19 diagnostic that can be performed completely at home and purchased without a prescription. Cue Health’s cartridge-based nasal swab test can be used solo or for children as young as two with adult supervision, regardless of whether a person is showing symptoms or suspects that they’ve been exposed directly to the coronavirus. The kit includes a single-use test and sample collecting wand as well as a battery-powered cartridge reader that connects to a smartphone app. Results are expected within 20 minutes. “For the first time, consumers can access laboratory-grade testing at home,” said Ayub Khattak, co-founder and CEO of Cue Health, which was recently named one of Fierce Medtech's 2020 Fierce 15. “With this FDA authorization, we are one step closer to achieving our mission of making molecular diagnostic testing available to anyone, anywhere, at any time through a connected healthcare delivery ecosystem,” Khattak said. In studies, Cue Health’s home test had a false-negative rate of 4% with zero false-positive results. And after raising more than $100 million in funding last year—plus a $481 million U.S. government contract to expand its manufacturing—the company said it expects to be able to produce more than 100,000 tests per day by this summer. To date, the FDA has authorized more than 330 different COVID-19 tests and sample collection kits, including molecular, antigen and antibody tests for the home, the lab and anywhere in between. The agency has also prioritized the review of diagnostics designed for the point of care as well as those that could help relieve the burden on centralized testing facilities.  The FDA also authorized Adaptive Biotechnologies’ DNA-sequencing blood test that identifies T-cell immune responses to the coronavirus to indicate a recent or prior infection—similar to an antibody test with high accuracy. This can determine whether the body’s white blood cells “remember” a previous exposure to the virus and potentially protect against a future infection.

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COPD World News - Week of March 7, 2021

Study looks at health inequalities regarding gender

Madrid, Spain - For decades, there has been gender imbalance when talking about different medical conditions. One key factor is that the “typical patient” has often been presented as male in descriptions and associated imagery. These thoughts regarding the “textbook patient” or the “typical medical case” are what creates health discrepancies and a dismissive attitude to other groups of individuals. Men and women should be equally represented in medical literature, medical artwork, clinical trials, etc. to allow for equal representation of both genders across all platforms. Creating a definition of a patient that all genders can relate to regarding their health is extremely important for the patient's own engagement with their health. In 2020, COPD remains a substantial cause of morbidity and mortality worldwide, creating a significant burden on the quality of life of people living with the condition and their families, social aspects of life and an increasing burden on the healthcare system. In Canada, for example, COPD is the fourth most common cause of hospitalisation in men and the sixth most common cause in women. In 2019, 850 000 Canadians over the age of 35 years reported a diagnosis of COPD. In the past, COPD has been thought of as a predominately male-dominated condition, an opinion that is immensely outdated, with a lack of awareness for women developing COPD. In women, the prevalence and mortality of COPD has significantly increased with figures suggesting a two-fold increase over the past 20 years. However, the incidence of men with COPD has stabilised. A cross-sectional study published in the International Journal of Chronic Obstructive Pulmonary Disease, from Spain, looked at the gender differences in COPD by identifying numerous clinical characteristics of the female participants. Of the 1610 participants recruited in the study, 17.9% were women. The study highlighted a significant difference between genders regarding the patient's smoking status, with higher numbers of men reported as current smokers and ex-smokers and more women with COPD who had never smoked (9.1% in comparison to the male participants reported at 0.6%). It has further been suggested that women are more susceptible to the effects of tobacco smoke, and there is evidence that exposure to environmental tobacco smoke is associated with COPD and affects women more often than men. Biomass smoke exposure has been associated with COPD in rural and urban women. In regard to the diagnosis of COPD, the time taken to diagnose a woman is often longer in comparison to a man with COPD and subsequently women are often identified at a later stage within the disease process. This poses difficulties in providing optimal early treatment and improving a patient's quality of life symptomatically. A delay in diagnosis can lead to increased anxiety for the patient and disengagement with their own health. Also, many women are unaware of the key symptoms of COPD, resulting in a failure to report their symptoms to their primary care physician.

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COPD World News - Week of February 28, 2021

EU told to back vaccine passports or Google or Apple may step in

Brussels, Belgium - European Union leaders inched toward establishing bloc-wide vaccine certificates to enable countries to reopen to travel as Commission President Ursula von der Leyen warned that unless they hurry Apple Inc. and Google will step into the vacuum.   During a five-hour video call, the EU’s 27 leaders focused on how to haul their nations back to a form of normalcy after a pandemic that’s claimed more than 500,000 lives and shut down large parts of their economies. While there was broad support for certificates of some sort, leaders didn’t agree on the type of privileges they would grant. “We have all agreed that we need vaccine certificates,” German Chancellor Angela Merkel told reporters after the talks on Thursday. “In the future, it will certainly be good to have such a certificate but that will not mean that only those who have such a passport will be able to travel; about that, no political decisions have been made yet.” Europe’s leaders have been anxious to find a response after facing criticism for a vaccination program that lagged behind the U.S. and U.K. There’s also the prospect of a third wave of infections leading again to stricter lockdowns. It was the first such meeting as prime minister of Italy for Mario Draghi, the former European Central Bank president. He asked leaders to adopt a more resolute and pragmatic approach to speed up vaccinations and told them the program has to move much faster, according to an official with knowledge of the call. Draghi also called for a tougher approach against companies that don’t respect delivery commitments, suggesting that their exports from the EU could be blocked not only during the period they don’t respect accords, but also for a certain period afterward. The growing support for a digital certificate with common criteria such as vaccination, negative testing or immunity was helped by Merkel seeming to soften her stance on the matter, backing work on such a document, according to two people familiar with her remarks. But von der Leyen urged the group to move faster before U.S. tech companies fill the void. “It is important to have a European solution because otherwise others will go into this vacuum,” she said at a press briefing. “Google and Apple are already offering solutions to the World Health Organization. And this is sensitive information so we want to be very clear here that we offer a European solution.” A spokesperson from the WHO said the organization has taken a software-neutral approach to the development of a vaccination certification and “neither Google nor Apple are involved in this process.”  A person familiar with Apple’s position on the matter suggested that von der Leyen had misunderstood the situation. Apple has never discussed a possible vaccine application with the WHO or the EU, the person said on condition of anonymity. “If we as European Union don’t provide a solution, somebody else will, whether it’s going to be the U.S. big tech companies or somebody else, the solution will be provided,” Alex Patelis, chief economic adviser to Greek Prime Minister Kyriakos Mitsotakis, told Bloomberg. “Let’s get the infrastructure ready.” Countries including Germany and Belgium have come under fire from the EU commission for closing frontiers with other European nations to keep the virus under control. While they said that non-essential travel should be restricted, their summit communique included no new commitments, merely reiterating that shutting borders should be proportionate and non-discriminatory.

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COPD World News - Week of February 21, 2021

Scottish study suggests COVID vaccine reduces risk of hospitalizations

London, UK - Scotland’s vaccination drive appears to be markedly reducing the risk of hospitalisation for COVID-19, suggesting that both the Pfizer-BioNtech and Oxford-AstraZeneca shots are highly effective in preventing severe infections, preliminary study findings showed on Monday. Results of the study, reported recently by Reuters, which covered the entire Scottish population of 5.4 million people, showed that by the fourth week after the initial dose, the Pfizer and AstraZeneca vaccines were found to reduce the risk of hospitalisation by up to 85% and 94% respectively. “These results are very encouraging and have given us great reasons to be optimistic for the future,” said Aziz Sheikh, a professor at the University of Edinburgh’s Usher Institute who co-led the study. Sheikh cautioned at a media briefing that the results are preliminary data, yet to be peer-reviewed by independent scientists, but added: “I am very encouraged. We now have national evidence ... that vaccination provides protection against COVID-19 hospitalisations.” He said he expected other countries using the same two vaccines and a similar strategy - such as England and Wales for example - would see a similar positive impact in reducing the number of people being hospitalised with COVID-19. Data for the vaccines’ effect in Scotland was gathered between Dec. 8 and Feb. 15. Researchers said that during this period, 1.14 million vaccines were administered and 21% of Scotland’s population had received a first dose. Among those aged 80 years and over - one of the highest risk groups for COVID-19 - vaccination was associated with an 81% reduction in hospitalisation risk in the fourth week, when the results for both vaccines were combined. Jim McMenamin, Public Health Scotland’s COVID-19 incident director, said the findings are particularly important “as we move from expectation to firm evidence of benefit from vaccines”.

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COPD World News - Week of February 14, 2021

Pfizer Canada head says company 'extremely committed' to meeting vaccine delivery targets

Montreal, PQ - The head of Pfizer Canada says the pharmaceutical giant is entirely focused on meeting its upcoming delivery targets and that it's possible the company could continue to accelerate shipments of its COVID-19 vaccine to the country. "Pfizer is extremely committed to meeting its contractual obligations, and we have every intention of meeting the four million commitment by the end of March that the prime minister has been talking about," Pfizer president Cole Pinnow said Sunday on Rosemary Barton Live. "As long as we're honouring our contract, we don't really feel that it's value added to talk about hypotheticals," Pinnow said, when asked by CBC Chief Political Correspondent Rosemary Barton about potential penalties for missed deadlines. The early months of Canada's COVID-19 inoculation campaign have been beset by disruptions to the delivery schedule. But on Friday, Prime Minister Justin Trudeau announced the country's vaccine supply would see a boost in the months ahead. Pfizer is now set to deliver 2.8 million more shots between April and June than originally planned. Deliveries previously earmarked for later in the year have also been moved up, meaning Canada will receive 6.2 million more doses than expected between July and August. Four million extra doses of the Moderna vaccine are also expected to arrive this summer. Most at risk, first in line: Public health experts say racialized Canadians should be prioritized for vaccines As far as the Pfizer-BioNTech product is concerned, Pinnow said it's not outside the realm of possibility that the company's deliveries to Canada could be shifted forward again. "We're going to continue to look for opportunities to accelerate delivery. We recognize that we want to bring back as much vaccine to Canadians as soon as possible." Pfizer's shipments to Canada dropped in recent weeks as the company's manufacturing plant in Puurs, Belgium, underwent upgrades to increase the production of its vaccine.  The company told the Globe and Mail last November that Canada would be sent doses from Pfizer's plant in Kalamazoo, Mich., but the company backtracked on that statement earlier this year. "We were working to accelerate the delivery to Canada of [the vaccine], based upon the accelerated review process that Health Canada had put in place," Pinnow told Barton. "So as part of that, we re-evaluated what our supply chain plan was going to be." A driver pulls his truck out of the Pfizer plant in Puurs, Belgium, on Dec. 21, 2020. Work to scale up manufacturing operations at the facility is now complete. (Valentin Bianchi/The Associated Press) When he was U.S. president, Donald Trump signed an executive order late last year aimed at ensuring Americans are given priority for receiving vaccines developed or procured by the United States government. "There was some uncertainty with the prior administration, and so we wanted to have confidence in where we were sourcing the product, and we felt that Belgium really provided us with more certainty at the time," Pinnow said. Canada is projected to receive 40 million doses of the Pfizer-BioNTech vaccine by September — the federal government's target month to vaccinate all Canadians seeking a jab. But under the agreement the country has signed with the pharmaceutical company, Canada can receive up to 76 million doses in total. "We're always open to talking about incremental demand or incremental supply," Pinnow said.

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COPD World News - Week of February 7, 2021

‘Multilayered approach’ to COVID-19 still needed as vaccine rollout continues

Boston, MA - It is still important for people who have been vaccinated against COVID-19 to wear masks and practice social distancing, experts said. “It remains important to practice well-established, evidence-based prevention measures,” Joshua Barocas, MD, an assistant professor of medicine at Boston University School of Medicine and infectious diseases physician at Boston Medical Center, said during an Infectious Diseases Society of America press briefing. IDSA experts encouraged continued mask wearing as vaccines continue to be distributed. According to the CDC, more than 27 million people in the United States have received at least one dose of COVID-19 vaccine, and more than 6.4 people have received the full two doses. The vaccine rollout, plus emerging real-world clinical trial data on vaccine effectiveness, has created “an encouraging period of time,” Barocas said, although he stressed that inequities in vaccine distribution will need to be worked out. “Vaccines do offer true risk reduction, and that is the good news, but it is important to remember that only a very small portion of the population has actually been vaccinated,” Barocas said. “People with the greatest need for protection have not been at the front of the line, and we know that there are existing and growing inequities in who has been vaccinated. Black and Latinx people, who are at the highest risk of infection currently, have been and are still the least likely to be vaccinated.” Barocas likened mask wearing to armor in a jousting match, noting that although it may not guarantee protection, it is still safer than to not wear it. He said that a “multilayered approach,” including mask wearing, social distancing and other proven mitigation efforts, will be needed even as vaccination continues.  Ricardo Franco, MD, an assistant professor of medicine at the University of Alabama at Birmingham and an associate scientist at the University of Alabama at Birmingham’s Center for AIDS Research, said during the briefing that emerging SARS-CoV-2 variants demonstrate the need for mitigation efforts, even among those who are vaccinated.  “The emergence of these variants only brings greater urgency. Once production of vaccines and provisions of supplies reach ideal capacity, we will only have optimal vaccine distribution when we inject greater resources to local health departments and we find creative ways to leverage retail stores and pharmacies to administer these vaccines,” he said. “It is also very important to quickly report the number of vaccine shots given back to the CDC, so we know in real time which locales are in need of allocation of additional vaccine vials in a timely manner.” The percentage of the population that needs to be vaccinated to achieve herd immunity is unclear, Franco said, and is a “moving target” driven by the population being studied, the vaccines being used and how a given population is prioritized for distribution. He also noted that vaccine hesitancy is a “concerning element” of distribution that may further increase the amount of time that mask wearing and social distancing will be necessary. “We need to remain committed to using all the tools we have,” Franco said.

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COPD World News - Week of January 31, 2021

The devastating toll of the COVID-19 pandemic on children

London, UK - From increasing rates of mental health problems to concerns about rising levels of abuse and neglect and the potential harm being done to the development of babies, the pandemic is threatening to have a devastating legacy on the nation's young. The closure of schools is, of course, damaging to children's education. But schools are not just a place for learning. They are places where kids socialise, develop emotionally and, for some, a refuge from troubled family life. Prof Russell Viner, president of the Royal College of Paediatrics and Child Health, perhaps put it most clearly when he told MPs on the Education Select Committee earlier this month: "When we close schools we close their lives." He says the pandemic has caused a range of harms to children across the board from being isolated and lonely to suffering from sleep problems and reduced physical activity. But it's not just the closure of schools. The stress the pandemic has put on families, with rising levels of unemployment and financial insecurity combined with the stay-at-home orders, has put strain on households up and down the land. The NSPCC says the amount of counselling for loneliness provided by its Childline service has risen by 10% since the pandemic started. Neil Homer, who has been volunteering for the service since 2009, has never known anything like it. "It's had a devastating impact," he says. The experience of this 16-year-old is typical of the calls that come in. "I feel really sad and lonely. Most days I find myself just lost in my own thoughts and feeling numb." Mental health problems on the rise Unsurprisingly, there are clear signs the upheaval in children's lives is having an impact on children's mental health. The Mental Health of Children and Young People in England 2020 report, which is produced by NHS Digital and the Office for National Statistics, is the official stocktake of the state of children's well-being. It has been tracking more than 3,000 young people over the last four years. Its latest findings, published in the autumn, found overall one in six children aged five to 16 had a probable mental health disorder, up from one in nine three years previously. Older girls had the highest rates. Children involved in the research cited family tensions and financial concerns as well as feeling isolated from friends and fear about the virus for causing their distress. Older teenagers and adolescents have been affected too as they have seen their prospects shrink. The Youth Index, published in January by the Prince's Trust in partnership with YouGov, has been tracking the well-being of young people aged 16 to 25 for 12 years. It found more than half of young people were always or often feeling anxious - the highest level ever recorded. Jonathan Townsend, of The Prince's Trust, fears young people are "losing all hope for their future". At the opposite end of the age spectrum, health visitors, who support parents and babies during the early years, are worried about the impact on newborns. Research shows the first two to three years of a baby's life is the most crucial period of human development. This has become known as the 1,001 days agenda. If children fall behind, they can find themselves at a lifelong disadvantage. The Institute of Health Visiting says services have been badly hit during the pandemic with these specialist nurses pulled away from their duties to help out on the Covid front line. In some areas, health visitor numbers have dropped by half. This and the social distancing rules mean for a lot of parents the only support they have received has been online. Meanwhile, the absence of baby and parent groups, and the friendships that naturally develop from them, has meant the babies of the pandemic have not benefited from the stimulus of social contact that is vital to their development. Alison Morton, head of the Institute of Health Visiting, says this has been an "invisible" cost of the pandemic, but one that will have a lasting impact, particularly in the most deprived areas. Babies and children, she says, are being "harmed" by what she says is the secondary indirect impact of the virus.

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COPD World News - Week of January 24, 2021

The pandemic has exposed a crisis in Canada’s long-term care homes

Toronto, ON - In late December the Tendercare Living Centre in Toronto became the site of an angry demonstration. Forty-eight of the home’s 200-odd residents had died from covid-19. Survivors’ relatives gathered to demand that it employ more staff. A doctor said the home had mixed infected with uninfected residents and had too little oxygen to treat the sick. She described it as a war zone. A hospital took over its management. By mid-January, 74 residents had died. The toll at Tendercare Living was an extreme example of a widespread problem. Deaths in Canada from covid-19 are about half those in the European Union as a share of population. Nearly three-quarters of the 14,000 Canadian deaths to mid-December took place in care homes. A study by the Canadian Institute for Health Information found that deaths in Canadian long-term care homes by late May were 25% higher than the average among 17 members of the OECD, a rich-country club, as a share of their populations. On December 31st The Toronto Star, Canada’s largest-circulation newspaper, published an editorial that took up the full front page decrying needless death in the long-term care system. It is “as if we have allowed [old people] to be put into coffins and buried alive before our very eyes”, the newspaper wrote. The crisis may soon subside. In Ontario, the most populous province (of which Toronto is the capital), all long-term care residents are due to be vaccinated by mid-February. But the problems highlighted by the pandemic will not disappear quickly. Canada consigns too many old people to institutions, one reason why such a high proportion of covid-19 deaths has taken place in them. They are poorly regulated, and many are badly designed. The problems will grow more pressing as the population ages. The share of Canadians older than 65 is expected to rise from a sixth to a quarter by 2041. In its treatment of old people Canada is an “international outlier”, says a recent report by Queen’s University’s School of Policy Studies. Canada spends less than most rich countries on long-term care: 1.3% of GDP (including the cost of compulsory insurance) compared with 1.7% on average by members of the OECD. That money is skewed towards institutions such as Tendercare Living rather than towards helping people remain in their own houses. In Canada 42% of people over 80 who need constant care are in institutions, compared with an OECD average of 30%. Denmark, which passed a law in 1987 that effectively barred construction of collective facilities, spends less on institutions than on home care, which is much cheaper. Canada, by contrast, spends six times more on institutional care. “We don’t do [home care] well. We default to institutional care,” says Fred Horne, a former health minister of the western province of Alberta.

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COPD World News - Week of January 17, 2021

Guelph student creates Covid-19 vaccination calculator

Guelph, ON - Jasmine Mah, a University of Guelph graduate, and Steven Wooding, a U.K. physicist, paired up and created an online tool that projects a date range for when a Canadian could expect to receive their double dose. The estimated timeline is based on factors such as your age, or whether you work in health care or with seniors in long-term care or live in an Indigenous community, all groups prioritized for Stage One of the federal rollout. Mah said she created the calculator  Vaccine Queue Calculator for Canada ( after hearing people talk about the pandemic being over because of the availability of vaccines. “I think people might be a little too over optimistic,” said Mah. “Yes, vaccines have been approved but we still have a ways to go. I don’t want people to let their guard down too early. We still have to be careful,” said the 28-year-old, who lives in Los Angeles with her husband, a Canadian doing post-doctoral work at a university there as well as in the U.K.  “Because I’m Canadian this topic was really important for me,” said Mah, who graduated from Guelph in 2018 with a masters in science. “I wanted to be a part of this and help people figure out when they are going to get their vaccine.” Mah has collaborated on calculators before, including one that estimated how much hand sanitizer a person would need to buy based on their usage.  The vaccine calculator is based on an earlier one done by Wooding for the U.K., which began delivering the vaccine about a week before Canada. The pair used the federal government’s vaccine rollout plan, which includes broad estimates of how many doses will be delivered in three-month timelines in 2021, as well as population and employment data from Statistics Canada.  In some cases, studies were used to determine, for instance, how many people in Canada live in long-term-care homes. And wherever possible, Mah said they tried to reduce the amount of double-counting in the priority categories so for instance, if someone was 80 years or older and lived in a long-term-care home, they aren’t counted twice.

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COPD World News - Week of January 10, 2021

Canada's vaccine rollout is slower than other countries

Regina, SK - Canada is falling behind in its initial rollout of COVID-19 vaccines at a critical time in the pandemic, and experts say our most vulnerable populations are being left at risk. Despite having months to prepare for the deployment of the initial shipment of vaccines to those most threatened by COVID-19 in long-term care facilities, a consistent rollout plan has yet to fully materialize on the ground.  "It just seems to be chaos right now," said Alyson Kelvin, an assistant professor at Dalhousie University and a virologist at the Canadian Centre for Vaccinology evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.  "We know who is a vulnerable population, so we need a strategy of actually vaccinating them." Long-term care residents were largely left out of Canada's initial rollout of the Pfizer-BioNTech vaccine, which requires storage temperatures of –80 to –60 C, in favour of waiting for the more easily transportable Moderna vaccine and vaccinating health-care workers first. But once thawed, the Pfizer-BioNTech vaccine can be used for up to five days at basic refrigeration temperatures — meaning it could be taken out of distribution hubs across the country and brought into long-term care facilities directly during that window of time.  A registered pharmacy technician prepares COVID-19 vaccines in Toronto on Dec. 15. (Evan Mitsui/CBC) "We treated the Pfizer vaccine with as much care and respect as possible and that really created all these hub sites," said Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton and an associate professor at McMaster University. "And I think that did hinder some of the innovation and the ability to do things elsewhere." The federal government has deployed almost 500,000 doses of both the Pfizer-BioNTech and Moderna vaccines to distribution sites across the country since mid-December, but the actual rollout of vaccinations is up to the individual provinces and territories.  Quebec took the bold step of actually putting its vaccine distribution centres inside long-term care facilities, making it easier to inoculate residents as quickly as possible.   British Columbia made the decision to move the Pfizer-BioNTech vaccine from its distribution sites almost immediately into long-term care homes to inoculate residents and staff upon receiving its first doses. Andy Yoon, 77, of Abbotsford, B.C., became the first long-term care resident in the Fraser Health region to receive the COVID-19 vaccine on Dec. 24. (Submitted by Fraser Health) Yet Ontario decided against bringing the Pfizer-BioNTech vaccine directly into long-term care homes initially, despite other provinces doing so, and is only now doing so more than three weeks after receiving its first shipment.  Dr. Vera Etches, Ottawa's medical officer of health, announced Tuesday the city would be transporting the Pfizer-BioNTech vaccine out of its distribution hub at the Ottawa Hospital and directly into long-term care residences, after vaccine-handling criteria from Pfizer were changed. Despite receiving 53,000 doses of the Moderna vaccine last week, which is much easier to bring into long-term care residences, only 3,000 doses have actually been administered in Ontario as of Tuesday. Ontario has pledged to vaccinate all residents, health-care workers and essential caregivers at long-term care homes in the hardest hit regions of Toronto, Peel, York and Windsor-Essex by Jan. 21, but has not set a deadline for the rest of the province.  To date, fewer than 1,000 long-term care residents have been vaccinated in Ontario. "The provincial health-care systems aren't experts in newly emerging viruses, brand new speedy vaccine platforms and pandemics," said Kelvin. For that reason, ongoing communication from the federal government to the provinces and territories and local level is essential, she said. "To leave each province and territory to have to come up with their own plan, when they're not experts in this, I think is a failure."  Kelvin said putting experts with relevant backgrounds in long-term care at the helm of vaccine rollouts across the country could have mitigated some of the missteps made so far. "We need somebody who's knowledgeable about long-term care facilities in Canada and their current functioning states," she said.

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COPD World News - Week of January 3, 2021

Symptom-less cases in schools could be key driver in spread of Covid-19

London, UK – Up to 70% of schoolchildren infected with coronavirus may not know they have it until after a positive test result. A key factor in the spread of Covid-19 in schools is symptomless cases. Most scientists believe that between 30% and 40% of adults do not display any Covid symptoms on the day of testing, even if they have been infected. For children, however, this figure is higher. “It is probably more like 50% for those in secondary school while for boys and girls in primary school, around 70% may not be displaying symptoms even though they have picked up the virus,” says Professor Martin Hibberd of the London School of Hygiene and Tropical Medicine. hat is a large proportion of symptom-free disease-carriers within a population. What is not yet known is just how much infection is being passed on by this cohort of young symptom-free carriers. It is a critically important issue, and one that will play a key role in determining the effect of Covid-19 on the people of Britain in the next few weeks, say researchers. Unfortunately a definitive answer on the infectiousness of young people remains tantalisingly out of reach, although there is evidence to suggest that people who don’t display symptoms of Covid-19 may have lower viral loads, which means they are less likely to infect others. This tendency correlates with age, so younger children have lower viral loads. As a result, they are less likely to display symptoms – and also less likely to pass on the virus. “It’s a real possibility but we cannot yet be sure,” says Hibberd. One solution to the problem is to increase testing in schools. This would require the widespread deployment of rapid testing, particularly with the lateral flow method, which is easily administered and gives results in less than half an hour. It is less accurate than the standard PCR swab test, however, and there have been concerns about a high level of false negative results leading to the continued spread of the new, more infectious, variant of the coronavirus. However, scientists point out that rapid tests are better at spotting individuals with high viral loads than those with lower ones. “We know that a high viral load is a key issue affecting the virus’s transmission, so even if we can’t detect every carrier, we are most likely to pick up those children who are more likely to transmit,” says Hibberd. “And frequent testing using other technologies – such as isothermal amplification (Lamp) testing – could further reduce the rate of false negatives. However, we have to be sure that we have a competent testing system in place in schools before we can be sure of that.”

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